A Friend or Just A Patient?

"Do you treat me as a friend or just a patient" A patient shot this question at me out of the blue one day.

In that split second, the neurons in my brain went into overdrive trying to formulate an answer that would not hurt her feelings and destroy my rapport with her and at the same time preserve the appropriate boundaries.

Please do not be mistaken, doctors do have friends outside the medical field. I have always enjoyed having a mug of beer with my group of secondary classmates of which none are doctors, listening to them talk about the world outside & dreaming about how nice it would be if I had done something else.

But really as doctors, we have boundaries to keep and this is in the patient's best interest. Just humour me and let me illustrate with this example.

Dr BL Og: Mum, I think you should really take your high blood pressure pills, you know if you don't take, you might get a stroke.....

Mother interrupts: Choi Choi Choi!!! Don't curse me arh Ah Boy! We Chinese people hate 2 things most, going to doctors and to matahs! Anyway you have been coughing for a few days, better drink the liang teh I brewed!

Dr BL Og: But mum, liang teh is not evidence based leh, I will prescribe meds for mysel......

Mother interrupts: What do you know! This is a special concoction left from your ah gong's ah gong's ah gong!!! You better drink or I spank your backside!

While the above conversation is fictional (or not), in reality, doctors have traditionally adopted a paternalistic approach in the practice of medicine. Over time, patients look upon doctors as authoritative figures. And it is exactly with this priviledge that we can instruct patients to take appropriate treatments. Even though medicine is moving towards a more consultative style (like our gahmen is apparently doing), in our asian society, the paternalistic way remains (which is what our gahmen actually is). So, my mother can never see her son as a fatherly figure and will never listen to my advice.

Likewise, if patients become our friends, will the paternalistic image be lost as well? Will the patients then stop listening to our advice?

The split second went by quickly and my answer to the patient was that it is more important for me to remain her doctor. She concurred that I would be more valuable to her as a doctor than I can ever be as a friend....... DOH!